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Care Planning & Reflection

Rana Saadaldeen

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 Learning outcomes
KNOWLEDGE& UNDERSTANDING
K1 discuss the Nsg. Process & its application to Nsg. Practice.
K2 select& discuss appropriate evidenced based Nsg. Interventions required in the
planning & achievement of negotiated, pt. centered outcomes.
K3 describe Orem’s Model of Nsg.
INTELECTUAL QUALITIES
I1 Apply a recognized model of Nsg. As a framework to the planning, implementation& evaluation
of care.
I2 Identify factors that impact upon the effectiveness of outcomes of care.
I3 Explain different Models of Reflection that can be applied to the Reflective process.
PROFESSIONAL/PRACTIXCAL SKILLS
P1 Demonstrate the ability to set person-centered goals\outcomes.
P2 Develop an individualized care plan that identifies the clients desired outcomes.
P3 Demonstrate the ability to evaluate the outcomes of care in relation to set objectives, & measures
the degree to which goals have been achieved.
TRANSEFABLE/KEY SKILLS
T1 Apply the principles of goal setting within a multidisciplinary context.
T2 Use Reflection to help determine whether to maintain, adapt or discontinue the plan of care.
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 TASK
Within this unit you are required to complete a
group task on care planning. This is a
developmental piece of group work that
requires you to build weekly on previous weeks
work.

At the end of the unit you will have completed a

care plan with your small group and you will
(with your group, represent a full care plan as
one final piece of work.

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 The nursing process and its application to nursing practice

It is essential to note that Conditional to registration as a Nurse is the ability to:-

1- Undertake and document a comprehensive, systematic and accurate nursing
assessment of the physical, psychological, social and spiritual needs of the patients,
clients and communities.
2- Provide a rationale for the care delivered which takes account of social, cultural,
spiritual, legal, political and economic influences.
3- Evaluate and document the outcomes of nursing and other interventions”
(DoH 2000a).
 Nursing Models ?! Purpose ?
The purpose of a Model of Nursing is to provide a framework for nurses to apply all
the stages of the nursing process in practice. (Help nurses organize their thinking
about nursing\ Understand nursing from a particular view point\ Engage in their
practice in an orderly and logical way).

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 The Nursing Process

Nsg. Diagnosis
Assessment (clinical judgment to
(Collecting information) Actual & potential
A systematic approach to nursing Health problems)
Which comprises
a series (or cycle) of steps
(Or stages) which, most commonly,
Are referred to as Assessing
Planning, implementing,
& evaluating. Planning
Evaluation (R.L.T 1990) (nurse & pt. set a plan
(feedback) (goals) to Assist with
solving a problem

Implementation
(apply the plan ) 6
 NURSING AS A PROFESSION

Profession can be defined as:

The possession of a unique body of knowledge, provision of an
altruistic service to society, and autonomy in the sense of
control over their work and work conditions
The main attributes of a profession:
1-a systematic& organized knowledge base
2-Public service & altruism (doing things for the benefit of others
rather than self).
3- Codes of ethics & regulation of professional conduct.
4-high levels of reward.

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 Why use the nursing process and models?
AUTONOMY----- “having the free will to select and act according to one’s
inclinations with independent thought and control over choice” (Wilkinson 1997).
Nursing Models help us to be autonomous through :
* providing a framework for applying the nursing process.
* providing Evidence based care (means making clinical decisions which are based
upon best available evidence).
 ACCOUNTABILITY---- “Being accountable means answering for your actions
 It is an integral part of professional practice concerned with
1- Weighing up the interests of patients in complex situations
2- Using professional knowledge, judgment and skills to make a
decision
3- Accounting for the decision made (UKCC Guidelines for
Professional practice 1996)

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 RE-CAP “ REVISION”

Assessment
 First stage of an ongoing, cyclical & multistage process.
 Involves collaboration with the patient to identify their actual and potential
problems.
 Involves the collection of data from a variety of sources.
 An effective assessment depends upon:-
– Identifying appropriate/relevant sources
– Pulling together information from these sources.

 Skills Involved: Active Listening \ Observing and Monitoring \Responding

appropriately to cues \Asking relevant, yet sensitive questions \ Conducting a
thorough physical examination \Accurately recording, cataloguing, integrating &
analyzing.
 What Information is Integral to an Assessment?
Subjective and objective information about:-
Physical health \Psychological well-being \Social health \ Spiritual needs \Cultural
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needs
 Nursing diagnosis
What Does Nursing Diagnosis Involve?
Making a "decisive statement concerning the clients needs"
(George 1995: 21)
"A statement that describes the actual or potential health problems of a client based
on a holistic assessment" (Weber 1991).
(Refers to a health problem \Based on objective and subjective assessment data \ A
short & concise statement of nursing judgment \ Condition for which the nurse can
independently prescribe \Can be validated by patient ) .
(Hogston and Simpson 2002. p.1 )

Nursing Diagnosis Some Key Points?

Differs from medical diagnosis\ Nursing focuses on whole unique person \Not just
on illness or disease \ Is the end product of nursing assessment \Is dependant upon
an accurate and comprehensive assessment \ Forms the basis for subsequent care
planning activities and therapeutic interventions

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What is the Relationship Between Nursing Diagnosis & Patient Problems?
Actual Problems - arise from the assessment
Potential Problems - could arise as a consequence of the actual problem
For Example:-
– Actual Problem: Pain as result of fractured ribs
– Potential Problem: Chest infection, due to poor ventilation as a result of
inadequate chest movements due to experienced pain. (Hogston and Simpson
2002.)

Nursing Diagnosis Characteristics:

* Is the end product of nursing assessment
* Is dependant upon an accurate and comprehensive assessment
* Forms the basis for subsequent care planning activities and therapeutic
interventions

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 Multidisciplinary care and the concept
of teamwork within nursing practice
The Multidisciplinary Team (Interprofessional and interdisciplinary) :
A team made up of professionals from different disciplines working together to
achieve the same goal.
 A Team can be defined as” a small number of people with complimentary skills
who are committed to a common purpose, performance goals & an approach for
which they hold themselves mutually accountable”.
*Teamwork relates to a group of people working together to achieve a common
goal
 Teamwork is sustained and improved when:
* each team member respects the differences and strengths of others.
* Good teamwork is built on respect and trust for each other.
* Must know their own role and the boundaries of that role.
* Each member of the team needs to have an understanding of the teams goals
* Each valuing the contribution they make and those made by others
* Effective care is the consequence of effective teamwork
(Semple and Cable 2003) Semple, M.and Cable, S. (2003) The New Code
of Professional Conduct. Nursing Standard. 17(23): 40-48.

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What is teamwork and what maintains it:
Working within a team however provides support to members in making
challenging decisions
Team members can also provide objective feedback on situations, have the
benefit of differing perspectives and ideas to a common solution.

Barriers to effective teamwork can be classified into three categories:

1- Internal Team Dynamics
2- External Influences
3- Individual Behaviour

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 Individual Behavior External Influences Internal Team
Dynamics
1-TIME

2- NON-COOPERATION
BY INDIVIDUAL

3- CRITISISM WUTHIN
THE TEAM 
4- RULES &
REGULATIONS 
5-COMPETITION\ SELF-
INTEREST 
6-POOR
COMMUNICATION 
7-LACK OF
COMMITMENT 
8-RESOURCES

9- GROUP SIZE\
STRUCTURE 
10-PHYSICAL WORK
SETTINGS  16
 Individual Behavior External Influences Internal Team
Dynamics
11-AUTHORITY
STRUCTURES 
12- TRAINING

13- ORGANIZATIONAL
CULTURE 
14-ROLE AMBIGUITY

15-CAREER
ASPIRATIONS 
16- SKILLS \ EDUCATION
\ KNOWLEDGE 
17- ATTITUDES &
BELIEFS 
18-MOTIVATION

19- TOO MUCH\ TOO
LITTLE LEADERSHIP 
20-ORGANIZATIONAL
GOAL \ STRATEGY  17
 Care Planning Task
This week you need to complete the following steps of the care
planning group work task:
Each small group will be given a specific profile\early next week.
The Ulster University care plan template must be used for the
completion of this group work.

Firstly, using a holistic approach, conduct a nursing assessment for

your patient using the patient profile specified for your group. You
then need to identify:
- 2 actual patient needs/problems of high priority
- 2 potential patient needs/problems of high priority
These need to be written as nursing diagnoses.
For example, one nursing diagnosis may be (potential problem)
John is at risk of falling due to poor mobility and requires the
assistance of 1 when mobilizing
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 Goal statement Section
2

STEP THREE IN THE nursing PROCESS: PLANNING/SETTING GOALS WITH A CLIENT.

  Prioritize problems/diagnoses
   Formulate expected outcomes
Choose nursing strategies
  Develop a care plan
Indicates the absolute desired outcome of the planned nursing care .
Types of Goals
• Short term goals are expected to be achieved in a relatively short period of time, usually less than a week.
• Long term goals are expected to be achieved over a relatively long period of time, usually weeks or months.

Goals statements provide four purposes

1- They provide direction for nursing interventions.
2- They provide a time span for planned activities.
3- They serve as criteria for evaluation of progress toward goal/outcome achievement.
4- They enable the patient and nurse to determine when the problem/need has been met
/addressed

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 Outcomes/Goals Nursing goals are simply the antithesis
• State how, what, when, and where. of the nursing diagnostic statement
 Outcomes/Goals in with a reasonable time frame. In other
words, diagnostic statements are
• Actual diagnosis the goal is to "problems" (negative).
restore health responses and prevent
Goals are "positive" (turn the nursing
complications.
diagnostic statement around).
• Potential the goal is to prevent the
If the nursing diagnosis is "Risk for
problem from occurring or maintain
Infection r/t..." for instance then the
present level of functioning.
goal statement might be "Client will
 Just as it was essential to validate
not experience infection throughout
the diagnosis with the client, it is
hospital stay AEB clear lung sounds,
necessary to work with the client to
afebrile, WBC count between 5,000
set health-related goals. What is seen and 11,000, wound site well
as a priority by the nurse may not be approximated with no purulent
seen important to a client and the drainage."
reverse can be true. Either the client
(or his/ her family if the client can not Goal statements always begin with
"The patient/ client will..." and have a
participate) should be involved in
specified time element.
picking the goals and discussing the
methods to achieve them. 20
 WRITING A GOAL STATEMENT

MACROS
CRITERIA THINK ABOUT
M---
MEASURABLE& IS IT CLEAR?
OBSERVABLE IS IT LINKED TO
A---ACHIEVABLE& THE NSG. DX.?
TIME LIMITED. WHEN POSSIBLE
C---CLIENT DOES THE PT.&\ OR
CENTERED. FAMILY AGREE
R---REALISTIC. THAT THIS IS THE
O---OUTCOME FOCUS OF CARE?
WRITTEN.
S---SHORT.

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 How
Once the problem list is complete,
look at each problem and ask the question,
"Will this problem get better?“

Can we keep this

from getting
YES any worse,
Then your goal will
NO
or developing
be for the problem complications?"
to resolve or show signs
of improvement
within the review
period Yes
acute setting, Then your goal will
the review period be for
may be as short the problem to
as next shift, intervene and prevent
next day or next or minimize
week complications.
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 PLANNING AND OUTCOMES SETTING GOALS WITH A CLIENT
o What are the goals for this There are three parts to a correctly
client? written goal statement. To remember
o
the three parts of SETTING GOALS
What do I want to accomplish?
WITH A CLIENT one can use GTT the
o How are my goals related to abbreviation for drop.
what the client wants to
G = Goal statement is written as " The
accomplish?
client will . . .'
o What are the expected T  = Time for evaluating goal
outcomes for this client? achievement is part of the statement:
o What interventions are to be " ...by noon today..."
used? T  = Tool for measuring goal
o Who is the best-qualified achievement is part of the statement:
person to person these "...as measured by..." 
interventions? One example of a short term goal
o How much involvement can statement would be;
the client and family or significant "The client will show involvement in
others have at this time? her own post-operative recovery by
o How much involvement does noon today as measured by turning side
the client wish to have at this to side, deep breathing and coughing
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time? every hour."
 Writing Goals/Outcomes
 Be sure that at least one outcome clearly demonstrates resolution of the problem cause.
Be sure the outcome is appropriate to the nursing diagnosis.
Be sure that each outcome has all the necessary components.
Be sure the outcome is valued by the client and the family.
Be sure the outcome is congruent with the total treatment plan.
Be sure each outcome is stated in terms of client responses and not nursing activities.
Be sure the outcomes are phrased in positive terms.
Be sure that each outcome addresses only 1 behavioral response.
Be sure the outcomes describe a client behavior or response that demonstrates the
desired improvement, resolution or prevention of the nursing diagnosis.
Be sure the outcomes are observable, measurable, and have a time factor.
Be sure the outcomes are specific and concrete.

Be sure the outcomes are realistic and achievable .

North American Nursing Diagnosis Association (NANDA).
Nursing Outcomes Classification (NOC) developed at the University of Iowa.
Nursing Interventions Classification (NIC) developed at the University of Iowa
Need help with writing Nursing interventions! Permalink

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 CARE PLANNING TASK\ CONT.

 BUILDING ON YOUR GROUP WORK IN THE

PREVIOUS WEEK & CONTINUING TO USE ULSTER
UNIVERSITY CARE PLAN DOCUMENTATION
COMPLETE BY
 DEVELOPING GOAL STATEMENTS TO ADDRESS
THE 4 NSG. DIAGNOSIS YOU HAVE SELECTED
WITH REFERENCE TO EACH OF THE ACTUAL &
POTENTIAL NEEDS\ PROBLEMS ULREADY
IDENTIFIED.
 USE MACRO CRITERIA

 GOOD LUCK

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 IMPLEMENTATION WK.3

2-Nsg. Diagnosis
1-Assessment (clinical judgment t
(Collecting information) Actual & potential
The Nursing Process Health problems)
A systematic approach to nursing
Which comprises
a series (or cycle) of steps
(Or stages) which, most commonly,
Are referred to as Assessing 3-Planning
Planning, implementing, (nurse & pt. set a
Evaluation plan
& evaluating.
(feedback) (R.L.T 1990) (goals) to Assist
with
4-Implementation solving a problem
(apply the plan ) Is where the
care is delivered and

the actions are carried out. 26

 The “Doing “ phase of the • The nurse has already
Nursing Process; been working
the initiation of designed nursing closely with her/ his client:
care plans into action toward achieving the
goal & expected outcome establishing rapport,
This step encompasses most of the physical care assessing, discussing
•client’s need identified( Dx)
teaching, support and
coordination

Actions
IMPLEMENTATION
are specific to
a particular goal;
each goal has its own list
of nursing actions.
Accompanying each nursing •Client's goals are established
Intervention is
a statement of its scientific rationale. Now that the client's goals
interventions should are established
Also be measurable nursing actions are selected that
realistic, & should be move those goals forward.
documented (planning) 27
 ALWAYS ENSURE THAT
WHAT DO WE NEED
THE NURSING INTERVE- TO ACHIEVE THIS
NTIONS REFLECT THE GOAL\ OUTCOME ?
DOING SOMETHING PRIORITIES OF THE PT.
AT THE GIVEN TIME. HOW?WHAT DO WE
NORMALLY DO?
A VERB IN
STATEMENT START WRITING WITH
VERBS
(OBSERVE, HELP,
WRITING THE MONITOR,DISCUSS,…)
NURSING
PRIORITISE NSG.
INTERVENTION INTERVENTIONS ACTIONS
ACTIONS (LOGICAL FORMAT; STEP BY
STEP EASY TO FOLLOW &
SUCCINCT”BRIEF”)

INSTRUCTIONS TO HOW CHECK FOR GUIDANCE

ACHIEVE “ OUTCOME OF CARE. FROM MOST UP-TO-DATE
NSG. LITERATURE
( THE USE OF EVIDENCE)
RATIONALE
PROVIDE A RATIONALE
(EVIDENCE-BASED PRACTICE ) FOR CARE(A REASON
DRIVEN FROM PROFESSIONAL “ EVIDANCE BASED” FOR
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KNOWLEDGR& UNDERSTANDING. PROVIDING THECARE)
THE LINK BETWEEN THE
OUTCOME/GOAL
STATEMENT AND THE
NURSING INTERVENTIONS.

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 SO WHAT DO WE MEAN BY EVIDENCED BASED
PRACTICE?
Evidence-Based Practice (EBP) requires that decisions about health
care are based on the best available, current, valid and relevant
evidence. These decisions should be made by those receiving care,
informed by the tacit (understood, not necessarily researched) and
explicit knowledge (gained from research) of those providing care,
within the context of available resources.

WE DO NOT CARRY OUT INTERVENTIONS BECAUSE THEY

HAVE ALWAYS BEEN CARRIED OUT TO MEET THIS GOAL,
WE DO THIS BECAUSE THE EVIDENCE SHOWS
THIS IS THE BEST WAY FORWARD.
AS PROFESSIONALS WE MUST BE ABLE TO STAND OVER OUR
PRACTICE AND JUSTIFY OUR DECISIONS.

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 CARE PLANNING TASK\ CONT.
For this section of the unit, you need to
complete the following steps as part of your
care planning group work activity:
Based on the evidence available:-
1- Plan the nursing interventions required to
meet the 4 goals you had set last week
2-You must provide a rationale for all of the
specified nursing interventions

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Evaluation 5 th
stage in NSG. PROCESS WK.4

2-Nsg. Diagnosis
1-Assessment
(clinical judgment
(Collecting information)
Actual & potential
Health problems

at i on ING
v a lu S MAK W 3-Planning
5-E ION I N HO G
AT ENTO RSIN (nurse & pt. set a
L U
EVA UDGEM THE N AVE
U plan
A J TIVE TION H THE (goals) to Assist
F F EC VEN V ING
E
IN TER
A CH IE with
IN E D L.
BEE
N SIR
DE E/GOA 4-Implementation solving a problem
OM
) Is where the
T C
OU
(apply the plan
care is delivered and

the actions are carried out. 32

 HOW DO WE EVALUATE CARE?
WHAT DID THE NURSES DO TO EVALUATE NURSING CARE?
HOW WAS CARE EVALUATED?

THE PROCESS OF EVALUATION IS CONCERNED WITH

CHECKING WHETHER THE NURSING INTERVENTIONS
HAVE BEEN EFFECTIVE IN REACHING THE
DESIRED PATIENT’S GOAL SET.

KEY SKILLS AND ACTIONS NEEDED TO MAKE AN EVALUATION

ARE:
* QUESTIONING THE PATIENT, THE PATIENTS FAMILY/FRIENDS,
OTHER NURSES, AND OTHER HEALTHCARE PROFESSIONALS.
* OBSERVING.
* MEASURING.
* COLLABORATING/ LIAISING.
* RECORDING AND REPORTING .
* RE-ASSESSING. 33
 SHOU
LD
EACH NUMBE
EVA THE R
DIAG NURSING
L NOSI
SHO UATIO
ULD N NUM S, AND
N EVAL BER
BE A OT COR UATI
“STO RESP ON T
RY” OND O
. THIS WITH
WRITING .
THE
EVALUATI
ON

U R S E H AVE TO
E A OF AN
B D EC I SIONS
LD ORD ESS MA K E
U C
HO RE IVEN RE, N D W R I T E THE
S A
IT ISE CT CA SO
C FE NG AL AL V A L U A T ION,
N F E
CO E E RSI ULD GO D TO
TH F NU HO THE ING MAY NEE S IN
O D S IF BE E O T H E R
AN CIFY , O R INVOLV HE
PE MET ET MAKING T
S S M I ON
I E VAL UAT 34
 “IF GOALS THE REGISTERED
ARE NOT NURSE SHOULD FEEL
MET, WHY AUTONOMOUS IN
NOT?”. HIS/HER DECISION
ON THE
EFFECTIVENESS OF
CARE.
IN COLLABORATION
WITH THE
THE GOAL MULTIDISCIPLINARY
SET WAS TEAM, PATIENT AND
NOT FAMILY
ACHIEVABL
THE NURSING
E OR WAS
INTERVENTIONS WERE PERHAPS THE
UNREALISTI
NOT CARRIED OUT PATIENT’S
C?
EFFECTIVELY, OR THEY CONDITION
WERE NOT THE CORRECT HAS CHANGED
INTERVENTIONS TO SIGNIFICANTL
ACHIEVE THE GOAL SET? Y?
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 John is 23, and has been admitted with acute abdominal pain in his right lower
quadrant. He states that the pain is “stabbing” and “sharp”. He rates the pain as
scoring 8 on a scale of 0-10 (0 being no pain and 10 being the worst pain possible”.
He is married with one child aged 3 months, and is the only person who is currently
earning an income within the household. He is very anxious about being in hospital
as he has never been in hospital before. John has also just been informed that he will
have to go to theatre for bowel surgery, and must now fast for theatre.
JOHN HAS ASSESSING PAIN IS ESSENTIAL
SHARP PAIN TO HELP ESTABLISH
IN HIS JOHN'S PERCEPTION
RIGHT SIDE OF THE PAIN EXPERIENCED
AS A RESULT SO THAT A BASELINE
OF A CAN BE ESTABLISHED.
SUSPECTED A PAIN SCALE IS A USEFUL
APPENDICITIS TOOL FOR PATIENTS TO BE
NURSE WILL: ABLE TO COMMUNICATE
1-ASSESS JOHNS PAIN THEIR PAIN (WOODS 2004).
JOHNS USING PAIN SCALE oUNRELIEVED PAIN CAN LEAD
PAIN WILL 3-4 HOURLY, TO FURTHER COMPLICATIONS,
BE RECORDING TYPE, FOR EXAMPLE, RED
REDUCED TO LOCATION AND UCED MOBILITY, ANXIETY,
WHAT HE EXPERIENCE OF PAIN SHALLOW BREATHING
FEELS IS 2-ADMINISTER
(LEADING TO POTENTIAL
AN CHEST INFECTION),
PRESCRIBED AND RAISED HEART RAT
ACCEPTABLE ANALGESIA AS
LEVEL. ?? (ALEXANDER ET AL., 2006).
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APPROPRIATE
 CARE PLANNING TASK\ CONT.

For this section of the unit, you need to complete

the remaining steps of your care planning group
work activity:
1-Explain the methods and process you would
adopt to evaluation the patient's progress and
the effectiveness of the nursing interventions.
2-Then identify the strengths & weaknesses of the
care plan you have developed.

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 Revisiting Reflection, and Developing your skills WK.5

of Reflecting on your experiences

Reflection means ... the throwing back of thoughts and memories,
in cognitive acts such as thinking, contemplation, meditation and
any other form of attentive consideration, in order to make sense
of them, and to make contextually appropriate changes if they are
required.
(Taylor, 2001, p3)
Reflection is the process that we consciously undertake to gain
further understanding and add meaning to our daily lives.
Reflection is associated with learning that has occurred through
experience and is an activity that helps you make sense of and
learn from situations.
Reflection, therefore is a means of assisting us to think, to explore
our thoughts and feelings and to work through an experience, in
an attempt to gain new understandings, fresh insights and self
awareness
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 Reflection encourages the uncovering and interpretation of
actions, thoughts feelings and behaviours all of which are present
during and following an experience.
The purpose of reflective practice is to enable practitioners to
• Assess • Learn • Understand
Through tried experiences AND then as a consequence take the
appropriate steps to improve practice. (Johns 1995)

 Reflection as a thoughtful process is required within nursing to

ensure that the nursing care that is given is required by that
individual, planned individually and evaluated appropriately.

 Reflective practice therefore is a means to encourage nurses to be

thoughtful in their care, seeing patients as unique individuals.

 In being Reflective, provide us with the desire to engage in nursing

interventions that facilitate more quality interactions with patients
and others.
 Reflection create the opportunity to modify and change practice as
required by the changing needs of the individual or situation 39
 Think
Reflection is an active process and
of the situation where all of the not a random process, undertaken
patients have to be bed bathed, out without thought.
of bed and have their breakfast all
When we as nurses are thinking
before 9am because the ward round
about our practice and are critical
starts then. Or every patient having
of it, we start to ask very
their temperature, pulse and blood
fundamental questions such as
pressure recorded at 10am.
• What are we doing?
Ask yourself:
• How is it being done?
• Of what benefit are these nursing • Why are we doing it this way?
interventions and routine practices • Does it need to be done?
to all of the patients? • Is this the best way to do it? If not,
• Do the tasks get completed much what other way is there?
more quickly?
• Is it easier to standardize nursing
care and provide the same care to Schon (1991) and Boud et al (1998)
all patients? suggest that Reflection helps
• Is this routine, ritualistic care integrate theory and practice,
safe? evidence based? respectful of encourages more critical 'thinking'
individuals need? and as such creates professionals
who are more critical 'doers'. 40
Reflection 'in' action occurs when the nurse working with a patient recognizes a
new situation and thinks about this situation in the midst of continuing to act on it,
that is, she/he is 'thinking whilst doing'.
Reflection 'on' action however is retrospective. That is, looking back on the
experience to discover and appreciate the knowledge used in the situation and the
need for further knowledge. Schon (1983)
Schon refers to these two times, viewing reflecting 'in action' as being associated
with thinking whilst acting - that is 'thinking on your feet'.
Guided reflection; reflection is a personal process that helps develop further
understanding, usually resulting in a change in behaviour , learner needs to
work with a supervisor. Johns (1995)

Gibbs' Reflective Cycle(1988)

When engaging in reflection,
DESCDIBTION
it is important that you:
Are spontaneous. THOUGHTS\FEELINGS
FUTURE ACTION
Express yourself freely.
Are open to ideas.
Choose a time to suit you. REFRAME
EVALUATION

Are prepared personally.

Choose a reflective method (Taylor, 2001)
ANALYSIS 41
 Using Taylor’s Model of Reflection
Taylor's model of reflection is derived from the work of Habermas (1972). In
his work, Habermas suggested that knowledge can be categorized as technical
(the interest of work) , practical (interaction) and emancipatory (power).
These are areas of interest that humans consider as important from which
knowledge can be gained and interpreted. These human interests according to
Habermas are based on and linked to parts of human existence.
Taylor adopted Habermas work and developed a reflective framework. She
identified three types of reflection as being:
1- Technical Reflection--This type of reflection has the potential for creating
opportunities for nurses to think critically in order to improve work practices,
particularly procedures and policies, through systematic questioning.
This systematic questioning is carried out within the steps of assessing,
planning, implementing and evaluating the whole procedure.
The outcome of the technical reflection can be immediate

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2- Practical Reflection---- is a means by which we as nurses can interpret and
understand human interactions through systematic questioning.
 It is a means to help you gain greater insight into the meaning of lived
experiences and to improve your communication with others within the clinical
environment. Having gained new insights and a raised awareness of the
interpersonal basis of human experiences, this in turn creates more
opportunities for change.
3- Emancipatory Reflection ---- Taylor suggests that through the process of
emancipatory reflection, nurses are in a better position to critique personal,
political sociocultural and economic features and constraints that are
impacting on their work lives.
 In this type of reflection, practitioners are able to examine the delicate and
clever powers and circumstances that hold practitioners back from achieving
desired goals.
The systematic questioning used within emancipatory reflection provides
practitioners with a greater ability to identify the problem or issue encountered
in their practice setting and the restrictions and limitations faced. These are
crucial steps in the process of creating changes in attitudes, behaviours and
practices.

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 Practical Reflection-
In using practical reflection the intended outcomes are to help you
• gain a greater understanding of the interpersonal basis of human experiences
• increase your potential for knowledge generation
• enhance your opportunities for interpretation of the lived experiences within
the environment that it is set (context) without bias and prejudice (subjectivity)
• strengthen your opportunity to affect change as a result of your increased
awareness of the nature of communication within professional practice
(Taylor, 2001).
The process of practical reflection:
Experiencing----- retelling a practice story so that you experience it again in as
much details as possible.
Interpreting----clarifying and explaining the meaning of a communicative action
situation.
Learning ------creating new insights and integrating them in into your existing
awareness and knowledge.

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 TASK
Using the process of practical reflection detailed below (Taylor’s model),
reflect on your experience of the team work within the care planning
group that you have just been involved in.
Remember
Within each piece of reflective writing you need to clearly identify
• what learning has occurred ?
show how this learning is linked to the theory related to the issue being
reflected on.
In addition you must clearly indicate the model and type of reflection you
have used to help guide the reflection.
This must be submitted online using the assignment drop box. The
submission date for this task is -----------

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 Summary
The Nursing Process is a five stage, cyclical framework for
delivering nursing care

2. The planning phase of the nursing process involves setting goals

to address the nursing diagnosis, and identifying the nursing
interventions required to meet these goals.
3. Goal statements should be linked to the nursing diagnosis, be
clearly written, be agreed with the patient, and meet the
MACROS criteria.

4. Nursing interventions are the evidence-based actions required

to achieve the goals set.

5. Nursing interventions must be written in a clear, logical, step-

by-step sequence, and have a rationale for their basis.
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 6. Evaluation should include the following steps:
a. Review the goal statement and ask ‘are we achieving this goal’?

b. If you are achieving the goal then say so. If not, identify the reasons.
c. Evaluate what has been successful about the care – you will want to ensure
that this successful element is maintained within the care plan.

d. In some cases where the goal may have been achieved, you can discontinue
the care in this area.

e. If the goal has not been achieved, check the nursing interventions. Are they
still appropriate or do they need revision? You may wish to add or subtract
from the plan of nursing interventions. You must show that the nursing
interventions have been reviewed. What aspects of the nursing interventions
may have been counterproductive to achieving the goal?
Perhaps the outcome needs to be modified. Was the goal set too ambitious? If
so, rewrite the goal statement in collaboration with the patient, family and
multidisciplinary team.

f. Always question the review date. You may need to review this outcome more
often. Maybe you had a short term goal that needed to be a long term goal.47
According to Taylor (2001) reflection is a means to create understanding that
helps us recognize the impact of our nursing actions and therefore provides us
with opportunities to improve our professional skills.
Therefore when you reflect on any experience you do not simply see more, you
do however see differently and as such you therefore act differently.
Reflection is an active process and not a random process, undertaken without
thought.
Nursing actions without though reduces opportunity to provide quality
individualized care.
The process of reflection on practice is not easy- but rewarding as it provides
new insights, new knowledge, and opportunities to alter practice to enhance the
outcome.
Reflection is a valuable means to help us understand the different types of
knowledge which is rooted within everyday nursing practice.
Taylor’s model of reflection is one framework that provides nurses with a
reflective approach to their work
• It is important to remember technical, practical and emancipatory types of
reflection identified but Taylor can be used in different aspects of your clinical
work.
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